Correlation Study Of Cardiac Auscultation Murmurs And Pulmonary Artery Pressure Measured By Echocardiography And Heart Catheterization Of PDA

Objective:By analyzing the pulmonary arterial pressure and intra-arterial blood flow velocity measured by echocardiography,pulmonary artery pressure and pressure difference in the ductus arteriosus measured by heart catheter,and the cardiac auscultation murmurs of the patent ductus arteriosus(PDA),We studied the correlation between cardiac auscultation murmurs,the pulmonary artery pressure measured by echocardiography and heart catheterization of PDA.To explore the evaluation of pulmonary artery pressure in patients with PDA by cardiac auscultation and Doppler echocardiography.To Instruct medical personnel to diagnose and analyze PDA,and guide and train professionals in epidemiological investigation,so as to realize early detection and early treatment for PDA patients.Methods:From January 2016 to December 2017,the cases of PDA-integrated hospitals diagnosed in Kunming Yan’an Hospital,were selected as subjects.A total of 148 cases were selected according to the inclusion and exclusion criteria,including 104 females and 44 males.The age range spans 1-64 years.The average age is(17.45±16.97)years old.All cases were examined by cardiac auscultation.Systolic pulmonary arterial pressure(SPAP-TTE),was estimated by transthoracic echocardiographic(TTE),systolic blood velocity peak(DAVs)and diastolic velocity peak(DAVd)were measured in the ductus arteriosus(DA).Systolic aortic pressure(SAP),diastolic aortic pressure(DAP)and systolic pulmonary arterial pressure(SPAP-Cath),diastolic pulmonary arterial pressure(DPAP-Cath)were measured by heart catheterization(HC).The cases were divided into four groups according to the characteristics of the cardiac auscultation,which were as follows:no murmurs(n=3),simple systolic murmurs(single phase murmurs)(n=14),systolic mainly and diastolic faintly murmurs(double phase murmurs)(n=28),and persistent murmurs(n=143).To analyze the correlation of DA-Vs,DA-Vd and SPAP-TTE measured by transthoracic echocardiographic,and the measured values of pulmonary artery pressure in cardiac catheterization,SPAP-Cath,DPAP-Cath,and the differential pressure of aortic pulmonary artery systolic pressure(ΔPs-Cath)and diastolic pressure difference(A Cath)in the catheterization.Results:1.The comparison of two methods to measure the pressure of pulmonary artery by TTE,namely,the tricuspid regurgitation estimation method(Tr),was compared with the method of pressure difference in the ductus arteriosus(ΔP),the result is p=0.003<0.05,and the measured values between the two methods were different,and the Tr method was smaller than the AP method.Correlation analysis showed that r=0.511 and P<0.05,two methods were positively correlated.The linear regression equation y = 5.043+1.046x.2.The difference between SPAP-TTE and SPAP-Cath of Tr method was p=0.027<0.05,the difference was statistically significant.The difference between SPAP-TTE and SPAP-Cath value of the AP method was p=0.106>0.05,and the difference was not statistically significant.Tr method of SPAP-TTE and SPAP-Cath linear correlation analysis results:r=0.776,P<0.05,had positives correlation,and have statistical significance.The linear regression equation y =-10.767+1.314x.Linear correlation analysis between SPAP-TTE and SPAP-Cath was performed by the ΔP method:r=0.595,P<0.05,had positives correlation,and have statistical significance.The linear regression equation y = 22.710+0.492x.3.The results of paired comparison in SPAP-Cath groups was that no murmur group and single phase murmur group’s P>0.05,the difference had no statistical significance.The paired comparison of the other groups’ P<0.05,they were statistically significant.In the group of Tr SPAP-TTE,the paired comparison was that no murmur group and single phase murmur group’s P>0.05,the difference had no statistical significance,The paired comparison of the other groups’ P<0.05,hey were statistically significant.4.By the change of character of murmurs from no murmurs group to single phase murmurs group to double phase murmurs group to persistent murmurs group,the rank correlation analysis of SPAP-Cath was r=-0.676,P<0.05,Tr method SPAP-TTE’s rank correlation analysis was r=-0.519,P<0.05.as the character relationship of auscultation murmurs changed,the cardiac catheterization and Tr method of TTE’s measured value were gradually reduced,both of two methods’measured value and the hierarchical relationship of murmurs had negative correlation,and this correlation expressed that the SPAP-Cath was slightly better than the Tr method of SPAP-TTE.5.DA-Vs was positively correlated with ΔPs-Cath,r=0.67,P<0.05.DA-Vd was positively correlated with ΔPd-Cath,r=0.82,P<0.05.The correlation analysis between the value of ΔPs-Cath and the value of APs-TTE was r=0.608,P<0.05,and there was a positive correlation between them.The values of ΔPs-Cath and delta ΔPs-TTE were p=0.111>0.05,and the results were not statistically significant.6.The P values of DA-Vs’s paired comparison were all less than 0.05,the difference were all statistically significant.In the paired comparison of DA-Vd,no murmur group and single phase murmur group were P>0.05,had no statistical significance,and the other groups were P<0.05,had statistical significance.The P values of ΔPs-Cath’s paired comparison were all less than 0.05,and the difference was statistically significant.In the paired comparison of ΔPd-Cath,no murmur group and single phase murmur group were P>0.05,had no statistical significance,and the other groups were P<0.05,had statistical significance.The DA-Vs and ΔPs-Cath rank analysis were r=0.61,r= 0.785,and P<0.05,respectively,both of them had a positive correlation with the hierarchical relationship of murmurs’ character.DA-Vd and ΔPd-Cath rank analysis were r=0.751,r=0.784,P<0.05,respectively,and both of them had a positive correlation with the hierarchical relationship of murmurs’character.The correlation of the pressure difference value measured by cardiac catheters was slightly better than the value of blood velocity peak measured by TTE.Conclusions:1.Echocardiographic measurement of pulmonary arterial pressure and cardiac catheterization measured pulmonary arterial pressure,Tr method estimates of pulmonary artery pressure were underestimated,and Δp method and cardiac catheter measurement of pulmonary arterial pressure did not differ.2.The character of PDA murmurs in clinical auscultation(from no murmurs to single phase murmurs to double phase murmurs to persistent murmurs)negatively correlated with pulmonary artery pressure.3.The character of PDA murmurs in clinical auscultation(rom no murmurs to single phase murmurs to double phase murmurs to persistent murmurs)was positively correlated with blood velocity peak in the ductus arteriosus and pressure difference between two sides of the ductus arteriosus.